Educating the next generation of pulmonary fellows in transbronchial needle aspiration leading the blind to see

Transbronchial needle aspiration (TBNA) remains an invaluable diagnostic tool in the evaluation of mediastinal and hilar abnormalities, specifically in the evaluation of patients with lung cancer. Training in TBNA has remained integral in pulmonary fellowship programs, but unfortunately the training methods, volumes, and outcomes have been variable. This has subsequently led to wide variations in practice patterns, diagnostic yield, and operator confidence. The introduction of endobronchial ultrasound-guided TBNA appears to have stimulated a resurgence in training and performance of TBNA. However, with this new technology, many questions have surfaced regarding training methods, volumes, and who should receive training. Within this context, we describe the history, current state, and future directions of the education of TBNA during pulmonary fellowship training.